| NPI | 1134010572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN L HAGAN Manager 210-500-6449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 183500000X Pharmacist | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 208000000X Pediatrics | |
| 251B00000X Case Management | |
| 261Q00000X Clinic/Center | |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-14 |